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Zhou R, Liu F, Zhang H, Wang D, Zhang P, Zheng S, Liu Y, Chen L, Guo J, Zou Y, Rong YM, Liu H, Qiu B. Fraction Dose Escalation of Hypofractionated Radiotherapy with Concurrent Chemotherapy and Subsequent Consolidation Immunotherapy in Locally Advanced Non-Small Cell Lung Cancer: A Phase I Study. Clin Cancer Res 2024; 30:2719-2728. [PMID: 38652815 DOI: 10.1158/1078-0432.ccr-23-3600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/20/2024] [Accepted: 04/19/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE This phase I trial aimed to determine the maximum tolerated fraction dose (MTFD) of hypofractionated radiotherapy (hypo-RT) combined with concurrent chemotherapy and subsequent consolidation immune checkpoint inhibitors (cICI) for patients with locally advanced non-small cell lung cancer. PATIENTS AND METHODS Split-course hypo-RT and hypoboost combined with concurrent chemotherapy was administered at three dose levels (DL), using a stepwise dose-escalation protocol. The sophisticated esophagus-sparing technique was implemented to restrict the dose to the esophagus. Patients who did not experience disease progression or unresolved ≥grade 2 (G2+) toxicities after RT received cICI. Each DL aimed to treat six patients. The MTFD was defined as the highest DL at which ≤2 patients of the six who were treated experienced treatment-related G3+ toxicity and ≤1 patient experienced G4+ toxicity within 12 months post-RT. RESULTS Eighteen patients were enrolled, with six patients in each DL. All patients completed hypo-RT and concurrent chemotherapy, and 16 (88.9%) received at least one infusion of cICI, with a median of 10 infusions. Within the 12-month assessment period, one patient in DL1 experienced G3 pneumonitis, and one patient in DL3 developed G3 tracheobronchitis. The MTFD was not reached. The objective response rate was 100%. With a median follow-up of 20.9 months, the 1-year overall survival and progression-free survival rates were 94.4% and 83.3%, respectively. CONCLUSIONS Utilizing the split-course hypo-RT and hypoboost approach, a fraction dose of 5 Gy to a total dose of 60 Gy, combined with concurrent chemotherapy and subsequent cICI, was well tolerated and yielded a promising objective response rate and survival outcomes.
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Affiliation(s)
- Rui Zhou
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Lung Cancer Institute of Sun Yat-sen University, Guangzhou, China
- Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - FangJie Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Lung Cancer Institute of Sun Yat-sen University, Guangzhou, China
- Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - HongMei Zhang
- Air Force Hospital of Southern Theater Command of the People's Liberation Army, Guangzhou, China
| | - DaQuan Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Lung Cancer Institute of Sun Yat-sen University, Guangzhou, China
- Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - PengXin Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Lung Cancer Institute of Sun Yat-sen University, Guangzhou, China
- Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - ShiYang Zheng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Lung Cancer Institute of Sun Yat-sen University, Guangzhou, China
- Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - YiMei Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Li Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - JinYu Guo
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Lung Cancer Institute of Sun Yat-sen University, Guangzhou, China
- Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - YingYi Zou
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Lung Cancer Institute of Sun Yat-sen University, Guangzhou, China
- Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - Yu-Ming Rong
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hui Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Lung Cancer Institute of Sun Yat-sen University, Guangzhou, China
- Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - Bo Qiu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Lung Cancer Institute of Sun Yat-sen University, Guangzhou, China
- Guangdong Association Study of Thoracic Oncology, Guangzhou, China
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Arulanantham J, Chelvarajah R, Ismail AK, Bray VJ, Vinod SK, Williamson JP. Central airway squamous metaplasia following radiation therapy mimicking local tumour recurrence. Respir Med Case Rep 2023; 46:101942. [PMID: 38025247 PMCID: PMC10665950 DOI: 10.1016/j.rmcr.2023.101942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Radiation therapy can result in injury to the lung parenchyma and central airways; the latter is less well documented in the literature. Here, we describe a 65-year-old Caucasian male, who developed focal endobronchial nodules and right main bronchial stenosis suggesting tumour recurrence, 32 months following curative intent concurrent chemoradiation therapy for Stage 3B squamous cell carcinoma of the lung. Computed tomography and positron emission tomography results are detailed. Flexible bronchoscopy with bronchial biopsies revealed squamous metaplasia rather than malignant tumour recurrence, with ongoing observation planned.
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Affiliation(s)
- Jonathan Arulanantham
- Faculty of Medicine Health and Human Sciences, Macquarie University, Balaclava Road, Macquarie Park, NSW, 2019, Australia
- The Northern Hospital, Northern Health, Cooper Street, Epping, VIC, 3076, Australia
| | - Revadhi Chelvarajah
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Campbell Street, Liverpool, NSW, 2170, Australia
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Therry Road, Campbelltown, NSW, 2560, Australia
| | - A Kasim Ismail
- Liverpool Hospital, Anatomical Pathology, Campbell Street, Liverpool, NSW, 2170, Australia
| | - Victoria J. Bray
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Campbell Street, Liverpool, NSW, 2170, Australia
| | - Shalini K. Vinod
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Campbell Street, Liverpool, NSW, 2170, Australia
- South West Sydney Clinical Campuses, Liverpool Hospital, The University of New South Wales, NSW, 2170, Australia
| | - Jonathan P. Williamson
- Faculty of Medicine Health and Human Sciences, Macquarie University, Balaclava Road, Macquarie Park, NSW, 2019, Australia
- South West Sydney Clinical Campuses, Liverpool Hospital, The University of New South Wales, NSW, 2170, Australia
- MQ Health Respiratory and Sleep, Macquarie University Hospital, NSW, 2109, Australia
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Ruan H, Xiong J. Value of carbon-ion radiotherapy for early stage non-small cell lung cancer. Clin Transl Radiat Oncol 2022; 36:16-23. [PMID: 35756194 PMCID: PMC9213230 DOI: 10.1016/j.ctro.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/06/2022] [Accepted: 06/13/2022] [Indexed: 12/24/2022] Open
Abstract
Carbon-ion radiotherapy (CIRT) is an important part of modern radiotherapy. Compared to conventional photon radiotherapy modalities, CIRT brings two major types of advantages to physical and biological aspects respectively. The physical advantages include a substantial dose delivery to the tumoral area and a minimization of dose damage to the surrounding tissue. The biological advantages include an increase in double-strand breaks (DSBs) in DNA structures, an upturn in oxygen enhancement ratio and an improvement of radiosensitivity compared with X-ray radiotherapy. The two advantages of CIRT are that the therapy not only inflicts major cytotoxic lesions on tumor cells, but it also protects the surrounding tissue. According to annual diagnoses, lung cancer is the second most common cancer worldwide, followed by breast cancer. However, lung cancer is the leading cause of cancer death. Patients with stage I non-small cell lung cancer (NSCLC) who are optimally received the treatment of lobectomy. Some patients with comorbidities or combined cardiopulmonary insufficiency have been shown to be unable to tolerate the treatment when combined with surgery. Consequentially, radiotherapy may be the best treatment option for this patient category. Multiple radiotherapy options are available for these cases, such as stereotactic body radiotherapy (SBRT), volumetric modulated arc therapy (VMAT), and intensity-modulated radiotherapy (IMRT). Although these treatments have brought some clinical benefits to some patients, the resulting adverse events (AEs), which include cardiotoxicity and radiation pneumonia, cannot be ignored. The damage and toxicity to normal tissue also limit the increase of tumor dose. Due to the significant physical and biological advantages brought by CIRT, some toxicity induced by radiotherapy may be avoided with CIRT Bragg Peak. CIRT brought clinical benefits to lung cancer patients, especially geriatric patients. This review introduced the clinical efficacy and research results for non-small cell lung cancer (NSCLC) with CIRT.
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Affiliation(s)
- Hanguang Ruan
- Department of Radiation Oncology, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan
- Gunma University Heavy Ion Medical Center, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan
- Department of Radiation Oncology, The Third Hospital of Nanchang, No 1248 Jiuzhou Avenue, Nanchang City 300002, China
| | - Juan Xiong
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Nanchang City 330029, China
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Wurstbauer K, Kazil M, Meinschad M, Pinter R, De Vries C, Clemens P, Kreuter C, Hernler T, Hitzl W, Cerkl P, Künzler T, De Vries A. Locally advanced NSCLC: a plea for sparing the ipsilateral normal lung-prospective, clinical trial with DART-bid (dose-differentiated accelerated radiation therapy, 1.8 Gy twice daily) by VMAT. Radiat Oncol 2022; 17:120. [PMID: 35799182 PMCID: PMC9264580 DOI: 10.1186/s13014-022-02083-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background In radiation treatment of locally advanced non-small cell lung cancer (LA-NSCLC), ‘margins’ from internal target volumes to planning target volumes in the range of 12 to 23 mm are reported, and avoiding exposure of the contralateral lung is common practice. We investigated prospectively an approach with tight margins (7 mm) and maximal sparing of the ipsilateral normal lung. Mature results for the first endpoint (pneumonitis) and further toxicities are reported. Methods Primary tumors were treated by VMAT with 73.8–90.0 Gy in positive correlation to tumor volumes, nodes with 61.2 Gy, a restricted volume of nodes electively with 45 Gy. Fractional doses of 1.8 Gy bid, interval 8 h. Before radiotherapy, two cycles platin-based chemotherapy were given. 12 patients finished maintenance therapy with Durvalumab. Median follow up time for all patients is 19.4 months, for patients alive 27.0 months (3.4–66.5 months). Results 100 consecutive, unselected patients with LA-NSCLC in stages II through IVA were enrolled (UICC/AJCC, 8th edition). No acute grade 4/5 toxicity occurred. Pneumonitis grade 2 and 3 was observed in 12% and 2% of patients, respectively; lowering the risk of pneumonitis grade ≥ 2 in comparison to the largest study in the literature investigating pneumonitis in LA-NSCLC, is significant (p < 0.0006). Acute esophageal toxicity grade 1, 2 and 3 occurred in 12%, 57% and 3% of patients, respectively. Two patients showed late bronchial stricture/atelectasis grade 2. In two patients with lethal pulmonary haemorrhages a treatment correlation cannot be excluded. Median overall survival for all stage III patients, and for those with ‘RTOG 0617 inclusion criteria’ is 46.6 and 50.0 months, respectively. Conclusions Overall toxicity is low. In comparison to results in the literature, maximal sparing the ipsilateral normal lung lowers the risk for pneumonitis significantly. Trial registration Ethics committee of Vorarlberg, Austria; EK-0.04-105, Registered 04/09/2017—Retrospectively registered. http://www.ethikkommission-vorarlberg.at
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Affiliation(s)
- Karl Wurstbauer
- Department for Radiation Oncology, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria.
| | - Margit Kazil
- Department for Radiation Oncology, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria
| | - Marco Meinschad
- Academic Teaching Hospital, Institute of Medical Physics, Feldkirch, Austria
| | - Raoul Pinter
- Department for Radiation Oncology, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria
| | - Catharina De Vries
- Department for Radiation Oncology, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria
| | - Patrick Clemens
- Department for Radiation Oncology, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria
| | - Christof Kreuter
- Department for Radiation Oncology, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria
| | - Tamara Hernler
- Department for Pneumology, Academic Teaching Hospital, Hohenems, Austria
| | - Wolfgang Hitzl
- Team Biostatistics and Publication of Clincial Studies, FM&TT, Paracelsus Medical University, Salzburg, Austria
| | - Peter Cerkl
- Department for Pneumology, Academic Teaching Hospital, Hohenems, Austria
| | - Thomas Künzler
- Academic Teaching Hospital, Institute of Medical Physics, Feldkirch, Austria
| | - Alexander De Vries
- Department for Radiation Oncology, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria
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Van den Heuvel F, Vella A, Fiorini F, Brooke M, Hill M, Ryan A, Maughan T, Giaccia A. Using oxygen dose histograms to quantify voxelised ultra-high dose rate (FLASH) effects in multiple radiation modalities. Phys Med Biol 2022; 67:125001. [PMID: 35594854 PMCID: PMC9174700 DOI: 10.1088/1361-6560/ac71ef] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/20/2022] [Indexed: 11/12/2022]
Abstract
Purpose.To introduce a methodology to predict tissue sparing effects in pulsed ultra-high dose rate radiation exposures which could be included in a dose-effect prediction system or treatment planning system and to illustrate it by using three published experiments.Methods and materials.The proposed system formalises the variability of oxygen levels as an oxygen dose histogram (ODH), which provides an instantaneous oxygen level at a delivered dose. The histogram concept alleviates the need for a mechanistic approach. At each given oxygen level the oxygen fixation concept is used to calculate the change in DNA-damage induction compared to the fully hypoxic case. Using the ODH concept it is possible to estimate the effect even in the case of multiple pulses, partial oxygen depletion, and spatial oxygen depletion. The system is illustrated by applying it to the seminal results by Town (Nat. 1967) on cell cultures and the pre-clinical experiment on cognitive effects by Montay-Gruelet al(2017Radiother. Oncol.124365-9).Results.The proposed system predicts that a possible FLASH-effect depends on the initial oxygenation level in tissue, the total dose delivered, pulse length and pulse repetition rate. The magnitude of the FLASH-effect is the result of a redundant system, in that it will have the same specific value for a different combination of these dependencies. The cell culture data are well represented, while a correlation between the pre-clinical experiments and the calculated values is highly significant (p < 0.01).Conclusions. A system based only on oxygen related effects is able to quantify most of the effects currently observed in FLASH-radiation.
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Affiliation(s)
- Frank Van den Heuvel
- University of Oxford, Department of Oncology, Oxford, United Kingdom
- Radiation Oncology, Zuidwest Radiotherapeutic Institute, Vlissingen (Flushing), Zeeland, The Netherlands
| | - Anna Vella
- University of Oxford, Department of Oncology, Oxford, United Kingdom
- Oxford University Hospitals, Department of Hæmatology & Oncology, Oxford, United Kingdom
| | - Francesca Fiorini
- University of Oxford, Department of Oncology, Oxford, United Kingdom
- Rutherford Cancer Centre Thames Valley, Reading, United Kingdom
| | - Mark Brooke
- University of Oxford, Department of Oncology, Oxford, United Kingdom
| | - Mark Hill
- University of Oxford, Department of Oncology, Oxford, United Kingdom
| | - Anderson Ryan
- University of Oxford, Department of Oncology, Oxford, United Kingdom
| | - Tim Maughan
- University of Oxford, Department of Oncology, Oxford, United Kingdom
- Oxford University Hospitals, Department of Hæmatology & Oncology, Oxford, United Kingdom
| | - Amato Giaccia
- University of Oxford, Department of Oncology, Oxford, United Kingdom
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Lindberg K, Onjukka E. Medical consequences of radiation exposure of the bronchi-what can we learn from high-dose precision radiation therapy? JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:S355-S370. [PMID: 34547741 DOI: 10.1088/1361-6498/ac28ef] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/21/2021] [Indexed: 06/13/2023]
Abstract
The bronchial tolerance to high doses of radiation is not fully understood. However, in the event of a radiological accident with unintended exposure of the central airways to high doses of radiation it would be important to be able to anticipate the clinical consequences given the magnitude of the absorbed dose to different parts of the bronchial tree. Stereotactic body radiation therapy (SBRT) is a radiation treatment technique involving a few large fractions of photon external-beam radiation delivered to a well-defined target in the body. Despite generally favourable results, with high local tumour control and low-toxicity profile, its utility for tumours located close to central thoracic structures has been questioned, considering reports of severe toxic symptoms such as haemoptysis (bleedings from the airways), bronchial necrosis, bronchial stenosis, fistulas and pneumonitis. In conjunction with patient- and tumour-related risk factors, recent studies have analysed the absorbed radiation dose to different thoracic structures of normal tissue to better understand their tolerance to these high doses per fraction. Although the specific mechanisms behind the toxicity are still partly unknown, dose to the proximal bronchial tree has been shown to correlate with high-grade radiation side effects. Still, there is no clear consensus on the tolerance dose of the different bronchial structures. Recent data indicate that a too high dose to a main bronchus may result in more severe clinical side effects as compared to a smaller sized bronchus. This review analyses the current knowledge on the clinical consequences of bronchial exposure to high dose hypofractionated radiation delivered with the SBRT technique, and the tolerance doses of the bronchi. It presents the current literature regarding types of high-grade clinical side effects, data on dose response and comments on other risk factors for high-grade toxic effects.
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Affiliation(s)
- Karin Lindberg
- Section of Head, Neck, Lung and Skin tumours, Department of Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Eva Onjukka
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
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Wallat EM, Wuschner AE, Flakus MJ, Christensen GE, Reinhardt JM, Shanmuganayagam D, Bayouth JE. Radiation-induced airway changes and downstream ventilation decline in a swine model. Biomed Phys Eng Express 2021; 7:10.1088/2057-1976/ac3197. [PMID: 34670195 PMCID: PMC8785227 DOI: 10.1088/2057-1976/ac3197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/20/2021] [Indexed: 11/11/2022]
Abstract
Purpose.To investigate indirect radiation-induced changes in airways as precursors to atelectasis post radiation therapy (RT).Methods.Three Wisconsin Miniature Swine (WMSTM) underwent a research course of 60 Gy in 5 fractions delivered to a targeted airway/vessel in the inferior left lung. The right lung received a max point dose <5 Gy. Airway segmentation was performed on the pre- and three months post-RT maximum inhale phase of the four-dimensional (4D) computed tomography (CT) scans. Changes in luminal area (Ai) and square root of wall area (WA) for each airway were investigated. Changes in ventilation were assessed using the Jacobian ratio and were measured in three different regions: the inferior left lung <5 Gy (ILL), the superior left lung <5 Gy (SLL), and the contralateral right lung <5 Gy (RL).Results.Airways (n = 25) in the right lung for all swine showed no significant changes (p = 0.48) in Ai post-RT compared to pre-RT. Airways (n = 28) in the left lung of all swine were found to have a significant decrease (p < 0.001) in Ai post-RT compared to pre-RT, correlated (Pearson R = -0.97) with airway dose. Additionally,WAdecreased significantly (p < 0.001) with airway dose. Lastly, the Jacobian ratio of the ILL (0.883) was lower than that of the SLL (0.932) and the RL (0.955).Conclusions.This work shows that for the swine analyzed, there were significant correlations between Ai andWAchange with radiation dose. Additionally, there was a decrease in lung function in the regions of the lung supplied by the irradiated airways compared to the regions supplied by unirradiated airways. These results support the hypothesis that airway dose should be considered during treatment planning in order to potentially preserve functional lung and reduce lung toxicities.
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Affiliation(s)
- Eric M Wallat
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53705, United States of America
| | - Antonia E Wuschner
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53705, United States of America
| | - Mattison J Flakus
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53705, United States of America
| | - Gary E Christensen
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA 52242, United States of America
- Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, United States of America
| | - Joseph M Reinhardt
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, United States of America
- Department of Radiology, University of Iowa, Iowa City, IA 52242, United States of America
| | - Dhanansayan Shanmuganayagam
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI 53705, United States of America
| | - John E Bayouth
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53705, United States of America
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